The effects of cardiac structure, valvular regurgitation, and left ventricular diastolic dysfunction on the diagnostic accuracy of Murray law-based quantitative flow ratio

作者：Yang, Junqing; Huang, Yuming; Li, Xiaoshan; Jia, Qianjun; Deng, Huiliang; Xie, Nianjin^*; Huang, Meiping^*; Fei, Hongwen^*

来源：Frontiers in Cardiovascular Medicine, 2023, 10: 1134623.

DOI：10.3389/fcvm.2023.1134623

• coronary hemodynamics
• coronary heart disease
• echocardiography
• fractional flow reserve
• quantitative flow ratio

ObjectiveThe study aimed to investigate the diagnostic accuracy of Murray law-based quantitative flow ratio (mu QFR) from a single angiographic view in patients with abnormal cardiac structure, left ventricular diastolic dysfunction, and valvular regurgitation.Background mu QFR is a novel fluid dynamics method for deriving fractional flow reserve (FFR). In addition, current studies of mu QFR mainly analyzed patients with normal cardiac structure and function. The accuracy of mu QFR when patients had abnormal cardiac structure, left ventricular diastolic dysfunction, and valvular regurgitation has not been clear.MethodsThis study retrospectively analyzed 261 patients with 286 vessels that underwent both FFR and mu QFR prior to intervention. The cardiac structure and function were measured using echocardiography. Pressure wire-derived FFR <= 0.80 was defined as hemodynamically significant coronary stenosis.Results mu QFR had a moderate correlation with FFR (r = 0.73, p < 0.001), and the Bland-Altman plot presented no difference between the mu QFR and FFR (0.006 +/- 0.075, p = 0.192). With FFR as the standard, the diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of mu QFR were 94.06% (90.65-96.50), 82.56% (72.87-89.90), 99.00% (96.44-99.88), 97.26 (89.91-99.30), and 92.96% (89.29-95.44), respectively. The concordance of mu QFR/FFR was not associated with abnormal cardiac structure, valvular regurgitation (aortic valve, mitral valve, and tricuspid valve), and left ventricular diastolic function. Coronary hemodynamics showed no difference between normality and abnormality of cardiac structure and left ventricular diastolic function. Coronary hemodynamics demonstrated no difference among valvular regurgitation (none, mild, moderate, or severe).Conclusion mu QFR showed an excellent agreement with FFR. The effect of abnormal cardiac structure, valvular regurgitation, and left ventricular diastolic function did not correlate with the diagnostic accuracy of mu QFR. Coronary hemodynamics showed no difference in patients with abnormal cardiac structure, valvular regurgitation, and left ventricular diastolic function.

• 单位
  南方医科大学; 广东省人民医院; 广东医学院; 广东省心血管病研究所